October 15th through December 7th is a period of time that Medicare has set aside to make changes to your Prescription Drug Plan (PDP) or Medicare Advantage Plan (MA) if you want. Whether you have a Medicare supplement and a stand-alone drug plan or a Medicare Advantage Plan with prescription drug coverage now is the time to review your drug plan for 2023. Like MA plans, drug plans have certain things you want to look at when considering which PDP is best for you. Those things are premium, deductibles, copays, coinsurance and the plan’s provider network.
Although the things listed above are most important so are the tiers that drugs are place into. So before we discuss the cost of the plans let’s look at drug plan tiers. Normally there are five tiers to a drug plan. Tier 1 and Tier 2 drugs are usually your most common generic drugs. Tier 3 drugs are preferred brand, Tier 4 drugs are non-preferred brand and Tier 5 drugs are specialty drugs. One of the most misunderstood parts of a drug plan is the tier a person’s drug is in.
Many people we meet with think that if their drug is listed in a certain tier under their current PDP it’s the same on all plans. This is not always true. Sometimes, for example, a drug may be listed a Tier 2 under one plan but may be a Tier 3 under another plan. Why is this important? Because in most drug plans the copays are higher for Tier 3 than Tier 2.
You can check the tiers of your drugs by looking at the plan’s formulary. The formulary is a list of the drugs that are covered by the plan. You can get the formulary of the plan you are considering by going to the plan’s website, going online to Medicare.gov or you can visit our office and we can help.
If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at firstname.lastname@example.org.